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empreinte. 

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d'images  nteessaire.  Les  diagrammes  sulvants 
illustrent  la  mithode. 


32X 


1 

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2 

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t^. 


REPORT  ON  SOME 

Anatomical  Variations 

FOR    1883. 
BY 

FRANCIS  J.  SiiEPHERD,  M.D., 

OK   MONTREAI,,    CANADA. 


REPRINT. 


BROOKLYN,  N.  Y., 

ANNAI.S    OF    ANATOMY    AND    SlIRCiKRY. 

18S3. 


-^^  _ 


■;'• 


:! 


n 


■;*• 


ON    SOME   ANATOMICAL   VARIATIONS,   WITH 
REMARKS  ON  THEIR  MORPHOLOGY. 

By  FRANCIS  J.  SHEPHERD,  M.D.,  CM.,  M.R.C.S.,  Eng., 

OF    MONTREAL,    CANADA, 

PROFESSOR   OF   ANATOMY  IN  MC  GILL   UMVF.RSITY  ;   SURflKON    TO   THK 
MONTREAL   GENERAL    HOSPITAL. 

THE  variations  described  below  are  some  of  the  most 
interesting  that  were  noticed  in  the  anatomical 
rooms  of  McGill  University  during  the  winter  session, 
1882-3. 

MENTO-HYOID    OR    HYO-MENTAL   MUSCLE. 

Three  examples  of  this  muscle  were  noted  ;  two  on  the 
left  side  and  one  on  the  right.  It  was  once  seen  on 
both  sides  of  the  same  subject.  In  the  first  case  this 
muscle  consisted  of  a  small  slip  quite  distinct  from  the 
anterior  belly  of  the  digastric.  It  arose  from  the  lower 
jaw  near  the  symphysis,  internal  to  the  attachment  of 
the  digastric,  and  passed  downwards  over  the  mylo-hyoid 
muscle,  to  be  inserted  into  the  body  of  the  hyoid  bone. 
In  this  case  the  left  digastric  had  two  anterior  bellies, 
the  supernumerary  one  being  given  off  from  the  fascia 
at  the  level  of  the  hyoid  bone. 

The  other  two  cases  occurred  in  the  same  subject. 
The  muscles  arose,  as  usual,  from  the  lower  jaw,  be- 
tween the  insertions  of  the  digastric,  but  did  not  reach 
the  hyoid  bone.  Spreading  out  as  they  descended,  they 
ended  in  a  strong  fascia  covering  the  mylo-hyoid,  and  at- 
tached below  to  the  hyoid  bone.     In  the  same  subject  the 

Reprinted  from  tlie  Annals  of  Analoiny  and  Snrgi'iy,  Vol.  viii.,  No.  4, 
October,  1SS3. 


/ 


4  FRANCIS  J.   SHEPHERD. 

right  digastric  gave  off  a  small  slip  of  muscle  which 
passed  beneath  the  meiito-hyoids,  and  blended  with  the 
mylo-hyoid  of  the  opposite  side. 

MacAlister  '  has  fully  described  this  muscle,  and  con- 
siders that  it  is  a  differentiated  portion  of  the  platysma. 
He  mentions  that,  in  one  case,  it  blended  with  the 
genio-hyoid,  the  intervening  portion  of  mylo-hyoid  be- 
ing absent.  The  last  variety  I  have  described  approaches 
this  form,  the  strong  fascia  into  which  the  muscle  is 
inserted  would  represent  the  subhyoidean  septum.  The 
mento-hyoid  or  hyo-mental  exists  normally  in  many  an- 
imals— c.  g.,  the  hippopotamus  and  bat.  Prof.  Hum- 
phry ^  considers  that  the  anterior  belly  in  man  is  form- 
ed from  the  middle  portion  of  the  hyo-fncntal,  which 
accounts  for  its  insertion  near  tlic  symphysis.  In  the 
cases  of  mento-hyoid  narrated  above,  it  is  the  inner  por- 
tion of  the  hyo-mental  which  persists  as  well  as  the  mid- 
dle. The  shifting  insertion  of  the  digastric  into  the  jaw 
in  many  of  the  lower  animals,  according  to  Prof.  Hum- 
phry, 3  is  explained  by  the  fact  that  its  anterior  belly 
may  be  formed  by  different  parts  of  the  hyo-mental  in 
difTerent  animals.  The  hyo-mental  (and,  of  course,  the 
anterior  belly  of  the  digastric)  is  formed  from  the  super- 
ficial brachio-ceph.dic  stratum  of  muscle. 

DOUiSLE   STVLO-IIYOID. 

This  anomaly  was  met  with  five  times  ;  twice  on  both 
sides  of  tlie  same  subject.  In  all  five  cases  the  extra 
muscle  took  the  place  of  the  stylo-hyoid  ligament,  and 
extended  between  the  styloid  process  and  lesser  cornu 
of  the  hyoid  bone  passing  beneath  the  hyo-glossus  mus- 
cle.    This  arrangement  is  found  in  some  of  the  edentata. 

*  Procecdiniis  Rii^al  Irisli  Acadenu',  vol.  xxv. 
-  Observations  in  Myoioy)-,  p.  13S. 
"  Luc.  cit. 


AN,i  TO  MICA  I.    VARIA  TIO.YS. 


(•II()NM)Rf)-S(:.\P('I,.\R 


K^ 


h}  i\ 


o 


TI 
f  tl 


lis    muscle  occuri'cc 


1  thr 


cc  limes  ;    once  on    both   siclei 


le  su 


bject. 


Tlie  first  example  met  with  was  on  tlie  left  side  of  a 
muscular  male  subject.  It  arose  by  a  round  tendon  from 
the  costal  cartilage  of  the  first  rib,  soon  devel(^[)ed  into 
a  large  fleshy  belly,  which,  after  running  parallel  to  the 
clavicle  for  a  short  distance,  crossed  beneath  it  and 
passed  o\'er  the  subclavian  artery,  ami  between  the  su- 
pra-scaj)ular  vein  and  artcr)-  ;  continuing  outwards,  it  end- 
ed by  being  inserted  into  uppi.r  border  of  the  scapula 
immediately  external  to  tlie  notch,  some  of  its  fibres 
were  attached  also  to  the  transverse  ligament  of  the 
notch.  In  this  subject,  on  the  same  side  (left)  there 
was  no  trace  of  a  subclavius,  and  the  omo  -  hyoid 
muscle  arose  from  the  middle  of  the  clavicle.  In 
the  same  subject,  and  on  the  left  side,  was  a  mento- 
hyoid  muscle,  and  tlie  anterior  belly  of  the  digastric 
was  double.      There  was  also  a  levator  thvroidea). 

The  other  two  examples  of  this  muscle  occurred  in  a 
muscular  male  subject.  The  course  on  each  side  was 
precisely  the  same.  The  muscle  arose  by  a  round  ten- 
don from  the  costal  cartilage  of  the  first  rib,  i)asscd  over 
the  clavicle  near  its  sternal  end,  and  piercing  the  cervi- 
cal fascia  above  the  clavicle  develojied  into  a  well-formed 
fleshy  belly,  which  crossed  the  scalenus  anticus  muscle  and 
third  part  of  the  subclavian  artery,  and  was  inserted  into 
the  root  of  the  coracoid  process.  On  each  side  the  sub- 
clavius was  of  small  size.  I  have  now  seen  seven  ex- 
amples of  this  muscle,  and  with  the  exception  of  these 
two  ((jccurring  in  the  same  subject),  all  [lassed  beneath 
the  clavicle.  In  the  Norway  rat,  guinea  pig,  wombat, 
etc.,  this  muscle  exists  as  the  sterno-scapular.  In  the 
horse    it    is    a    well-developed    muscle.      In    tlic    first    case 


i  II 


^  J 


^'  to   ^vivc    cmboaiccl    the 

::r:;:-:,:  r."-- »- • ' '" 

r.<  t-Vie  subcUvvius. 

o..u,o.occu.vu..  ^        ^^^^^^^^ 

Two   eK...ples  of   tHs  muscle  were    s..^  .^^      ^^   ^^_^^ 
occurred  on  the  riglu   sk        <  ^^^  ^^^^  ^,^_^,^,^^  ,    , 

,„,„  ,,e  ..KUne  of  the       u .    b  ^_^_^^.  ^^^^^^^    ^^^^ 

!'-->    up   a,  .   .--^      '      ,no-ma.toUl,  to  be  inserted 
Ld  quite  distinct  from  ^h  J^  ^^^^.^^  „,„  ,,erno- 

i„to  the  occipital  bone,  ^e'-  ^^^  „„  „„  ,e(t   sale   of 

„,astoid.    The   second   ca.c   occ  _^^^^^^^^^   ^^^ 

,   female   subject.      U   »-  J,^;.^,  i„,,rtion  it  blended 
ioregoing.  as  immed.a.ely  b  .o,  ^^  ^^^,,  ,^_^^,^,  „ 

,Uh  the  stcrno-masto,       Th^-  ^^^^^  ^„  ,,„.,  woo    • 

,,e  l'-'S'^f*;™':;rhun,eral  muscle  of  many  of  the 

corresponds  to  tne      i 

,„,„cr  animals.  ^^^^^^  ^^_^_^^_^^^^ 

on  -  - -7- :"r '^s ::- :::^-- 

ample  of  this  muscle^  »^^  s       ■  ^  ^^^^^  ^^„,,„„„, 

the  costal  cartdage  of  the  fit  ^^^^^^  ^^^^^  ^,^;^,  ,„,. 

expansion,  passed  upwards  over  ^^^^^  ^^^^^^^^^  ^^ 

Ul  cartilages  -  fj^t  m^^il  1-*-'.  '--«'•  "'^ 
a  (ew  aponeurotic  fibres,  ^,^^   ,,,„„  p^,. 

attached  to  the  first  -stal  -     '=^»  ^^^^  ,,,   fi.st 

tion  ended  in  a  -"^"^J^'f^^^.^^o^s  with  the  inner 
piece  of  the  sternum,  became  ^.^^,     ^,,^ 

lorder  of  the  s-mo-masto.d  of  h  PP^  _^^^^^  ^^^^^_^. 
muscle  was  in  no  way  conn    ted  _^^.^^    ^^^^ 

„U,    and    was    superfic.al    to    the    p 

Fig.  !)• 


.  proceedings  Royal  Society,  .870. 


'  -i  • 


ANATOMICAL    I'.lNl  A  TIOS'S.  J 

I'i'Mf.  'runicr.  '  ill  ,1  must  inti'icstiii;.^-  essay  on  tin's  mus- 
cle, holds  tii.it  it  is  not,  as  was  formerly  supposed, 
h()nU)lo<4()iis  with  the  anterior  (tr  pectoral  <c\m\  of  the  rec- 
tus al)(himinis.  The  rectus,  when  proloni^cd  upwards  in 
the  lower  animals,  is  always  beneath,  or  rather  deeper 
than  the  ^n-eat  i)ectoral  muscle.  I'he  rectus  sternalis 
of  man  is  always  superficial,  so  Prof.  Turner »  regards  it 
"as    an    additional    rudiment    in    man    of    that    very    ini- 


\ 


St.M. 


■R.S. 


FIG.    I.       RECTUS    STERNALIS   MUSCLE. 

A',  .v.,  rectus  sternalis;  .SV.  M.,  sterno-mastoid  ;  P.  M.,  pectoralis  major. 


portant  tegumentary  muscle  (the  panniculus  carnosus ), 
though  it  must  be  admitted  that  the  human  platysma  lies 
on  a  plane  superficial  to  the  fibres  of  the  sternalis  in 
those  individuals  in  whom  they  co-exist."  I  have  seen 
one  case   of    rectus   sternalis    which    was   continuous   with 


^  Journal  of  Anatomy  and  Physiology,  vol.  i. 
*  Loc.  cit. 


(f 


8 


/'/i.ti\c/s  /  snEPiiEKn. 


the-  i,!atysm;i.  hut  the  case  drccrihcd  al)ovc-  was  chrcctly 
ccntinuous  witli  the  sterno-niastoid.  and  s..mc  anatomists 
(llenK:,  Thcile,  and  others)  consider  this  muscle  a  cntin- 
uation 'downwards  of  the  sterno-mastoid.  as  in  man,  when 
it  exists,  it  is  so  often  connected  witli  the  sterno-mast- 
old.  I.i  many  mammals  the  attachmoits  of  the  sterno- 
mastoids    are    continued    l,ackwards  superficial  to  the  pec- 

toralis   major. ^ 

Dr.  (i.  l'^.  Dohson'-J  looks  upon  the  niKSiii/its  stirnnlts 
"as  homolo^rous,  not  with  the  paniiiaihis  avnosus  lining; 
the  inte-ument,  but  with  the  sterno-cuticularis  (sterno- 
facialis  of  the  hed^re-ho-).  which  is  found  in  many  spec.es 
of  mammals  sprinoin-  from  the  sternum  and  attached  to 
the  deep  surface  of  th>,-  painnniliis  cariwsus  either  in  front 
of  or  behind  the  anterior  extremity."  This,  however, 
does  not  satisfactorily  account  for  its  continuation  in 
many  cases  with  the  sterno-mastoid. 

PECTORALIS   MINOR. 
In  three  cases  this  muscle  blended  with  the  coraco-bra- 
chialis,  or   more  properly  speaking,   its    lower   border   was 
inserted    into   the  coraco-brachialis,  forming    at    the    pomt 
of  junction    a    broad  tendinous    intersection.     It  was  once 
seen  having   no    insertion    into    the    coracoid    process,   but 
the   whole   brachial    end    was    fused    with     the   coraco-bra- 
chialis for  about  two  inches.     This  is  an  approach   to  the 
insertion  of  the  pectoralis  minor   into   the  humerus,  as   is 
seen  in  quadrumana  and  some  of  the  carnivora. 
DOUBLE   CORACO-15RACIIIALIS. 
On  the  right  side  of  a  male  subject  the  coraco-brachia- 
lis had  two  insertions:  (i)  the  normal  one   into  the  inner 
side  of  the  middle  of  the  humerus,  and  (2)  a  second  one 

1  Prof.  Turner,  loc.  cit. 

*  Journal  of  Anatomy  and  Physiology,  October  1882. 


I 


1 


i 


A  NT  A  TOAf/CA  I.   VA  K I A  TIONS. 


r 


\ 


•f 


\ 


into    tlu.'    intern. il    i-ondylc    of    the    luimcrns.     The    super- 
numerary portion  arose  with  the  normal  muscle  from  the 
coracoid  process,  and  consisted  of  a  strong  muscular   slip 
which  passed  down  the  ,irin  internal  to  it  ;  after  crossin{» 
the  vessels  and   ne.ves  of   the   arm    about  its  middle,    the 
slip    became    tendinous.      This    ten<lon    blended  internally 
with  a  broad  aponeurotic    band,  which    covered  the  inter- 
nal   portion    of    the    triceps    muscle  and   the  ulnar  nerve, 
and  reached  from  near  the  head    of   the    humerus    to    the 
internal    condyle.      The    tendon    proper   of    the    muscular 
slip  above  described  continued    on,  and  was  inserted  into 
the    lower   part    of   the    internal    condyloid    rid^n>.       Prof. 
Wooil  >   has    fully  described  a  siiriilar  anomaly,  and    men- 
tions   that    he    has    met    with    three    varieties    of    coraco- 
brachialis   muscle  in  man:     (i)  The   normal    arranj^ement, 
which     he     c.dls     the     coraco  -  brachialis    proprius  ;     (2) 
where    the    muscle    is   inserted    into   the    internal    condyle 
(coraco-brachialis  longus^  ;  and  (3)  the  rarest  variety  where 
the   muscle   is   inserted   into  the    capsule    of   the    shoulder 
close  to  its  insertion  into  the  anatomical  neck  of  the  hu- 
merus, immediately  below  the  lesser  tuberosity.     This  has 
been  described  as  the  coraco-capsularis.     Prof.  Wood  calls 
it  the  coraco-brachialis  superior  vel  brevis.     All  these  va- 
rieties  exist    normally    in    the    lower   animals.     In    a    bear 
which   I   lately  dissected,  the  short    and    lon^j  variety   ex- 
isted.    In   most  of  the  quadrumana  there  is  a   double  in- 
sertion   of   this    muscle,    in    the    dog    and    cat    the    short 
variety  alone   exists,  2   and  in  the  guinea  pig  the  median 
variety  only  is   present,   as   in   man. 

FLEXOR   INDICTS. 
On  the  right  side  of  a  male  subject  there  was  a  distinct 
flexor  indicis  muscle,  separated  from    the    profundus  by  a 

^  Journal  of  AiuUoDty  and  Physiolo^^y,  vol.  i. 
8  Prof.  Wood,  loc.  cit. 


fi 


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,0  FRANCIS  J.  SHEPHERD. 

well-marked  cellular  interval.  It  was  of  considerable  size, 
and  arose  from  a  small  portion  of  the  ulna,  the  interosseous 
membrane  and  a  portion  of  the  radius  internal  to  the 
flexor  poilicis ;  there  was  a  well-marked  tendinous  mtersec- 
tion  between  it  and  the  flexor  poilicis.  In  the  ourang, 
chimpanzee,  and  gorilla,  there  is  a  distinct  flexor  indicis.^ 

FIBULO-ACCESSORIUS. 
This  supernumerary  musc.e  arose  on  both  sides  of  the 
same  subject  from  the  lower  fifth  of  the  posterior  border  of 
the  fibula,  its  fibres  blending  with  those  of  the  peroneus 
tertin.  its  course  was  then  downwards  behind  the  mner 
m: '  and  posterior  to  the  flexor  hallucis,  where  it  end- 

ed 1  -nid  tendon  which  grooved  the  astragalus  and  os 

calcis  and  was  enclosed  in  a  separate  sheath  ;  it  finally  end- 
ed by  being  inserted  into  the  deep  surface  of  the  long  flexor 
tendon  with  the  accessorius.  I  have  several  times  seen  a 
similar  slip,  which  arose  from  the  lower  part  of  the  tibua 
(tibio-accessorius),  but  never  before  one  quite  like  this.  It 
probably  was  a  differentiated  portion  of  the  longus  hallucis. 
Its  morphology  I  am  unable  to  determine. 

TRIPLE  ANTERIOR  COMMUNICATING  ARTERY. 
In  the  brain  of  a  female  subject  the  two  anterior  cerebral 
arteries  were  connected  together  by  three  distinct  commu- 
nicating arteries.  They  were  of  small  size.  I  have  fre- 
quently seen  the  anterior  communicating  artery  so  short 
that  the  two  anterior  cerebrals  seemed  fused  together,  but 
this  is  the  first  time  I  have  seen  it  multiple.  The  two  cere- 
bral arteries  in  this  case  were  separated  by  a  considerable 

INTERNAL   MAMMARY. 
This  artery  was  once  seen  to  come  off  from  the  thyroid 
axis,  and  it,  in  another  case,  gave  off  the  suprascapular. 
1  W.  J.  Walsham,  St  Baitholomew's  Hospital  Reports,  i88o. 


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ANA  TOMICAL   VARIA  T/ONS. 


II 


i 

9 


ABERRANT  ARTERY. 

On  the  left  side  of  a  male  subject,  opposite  the  insertion 
oi  the  u;tissimus  dorsi,  a  large  branch  was  given  off  from 
the  brachial  which  passed  down  the  arm  internal  and  paral- 
lel to  the  brachial,  and  joinea  it  again  at  the  bend  of  the 
elbow.  The  main  artery,  after  receiving  the  aberrant 
branch,  almost  immediately  divided  into  radial  and  ulnar. 
The  aberrant  artery  was  quite  as  large  as  the  brachial, 
which,  in  this  instance,  was  smaller  than  usual. 

INTERNAL   CIRCUMFLEX    FROM   THE    DEEP   EPKJASTRIC. 

This  occurred  on   the  left  side  of  a  male  subject.     The 
epigastric  arose  from  the  external  ili^ic,  about  half  an  inch 
above  Poupart's  ligament,  and  almost  immediately  gave  off 
the  internal  circumflex.     From  this  origin  the  internal  cir- 
cumflex passed  beneath  Poupart's  ligament,  within  the  fem- 
oral sheath  (being  enclosed  in  the  same  compartment  as  the 
common  femoral),  and  continued  down  the  thigh  for  nearly 
two  inches,    lying  between  the  femoral    vein    and   artery  ; 
it  then    gradually  proceeded    inwards    across    the    femoral 
vein  to  dip  down  between  the  pectineus  and  psoas  muscles. 
Before  doing  so,  it  gave  off  a  large  branch,  corresponding  to 
a  portion  of  the  profunda,  which  was  distributed  to  the  ad- 
ductor muscles  (see  Fig.  2).     The  external  circumflex  was 
given  ofT  directly  from  the  femoral,  and  the  profunda  did 
not  come  off  till  the  main  artery  reached  the  apex  of  Scar- 
pa's triangle.     It  was  of  small  size.     In  a  bear  which  I  late- 
ly dissected,  on  both  sides  the  internal  circumflex  was  of 
large  size,  and  was  given  off  from  the  external  iliac  some  dis- 
tance above  Poupart's  ligament,  and  continued  downwards 
within    the    femoral    sheath,    lying   between   the    vein  and 
the  artery ;  about  an  inch  below  Poupart's  ligament  it  pro- 
ceeded  to  its  destination  by  dipping  down  between  the  vein 
and  artery.     I  have  several  times  seen  the  internal  circum- 


p  ' '  • 


'/  ^  ♦ 


12 


FRA  NCIS  /.   5//i^'  I' HERD. 


flex  and  ilccp  epigastric  arteries  given  o\[  from  a  common  . 
trunk,  and  once  I  noticed  a  common  trunk  for  the  internal 
circumflex,  epigastric  and  obturator  ;  but  in  all  cases  this 
occurred  bclozv  Poupart's  ligament.  This  is  the  first  time  I 
have  seen  this  rare  anomaly  of  the  internal  circumflex  aris- 
ing with  the  epigastric  above    the    ligament.     Mr.    Arthur 


FIG.    2.       ABNORMAL   ORIGIN    OF    INTERNAL   CIRCUMFLEX    ARTERY. 

P  Poupart's  ligament;  E.,  epigastric  artery;  /.,  internal  circumflex; 
A.,  branch  from  circumflex  to  adductor  muscles;  E.  C,  external  circum- 
flex ;  P.  F.,  profunda  (emoris. 

Thompson,  i  in  a  recent  number  of  the  Journal  of  Anatomy 
and  Physiology,  gives  an  account  of  two  cases  in  which  there 
was  this  unusual  arrangement  of  the  arteries.  In  one  case 
the  internal  circumflex,  after  leaving  the  epigastric,  curved 

»  April,  1883. 


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ANA  TOMICAL   VARIA  TIONS. 


13 


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inwards  and  downwards,  lying  internal  to  the  femoral  vein 
and  winding  to  the  inner  side  of  the  crural  ring,  where  it 
gave  off  the  external  pudic.  It  then  rested  on  the  pectineus 
muscle,  being  bound  down  to  it  by  strong  fascia.  The 
artery  being  in  this  position  would,  in  the  event  of  a  hernia 
coming  down,  surround  the  neck  of  the  sac,  and,  in  case  of 
operation,  would  be  in  danger  of  being  wounded.  It  would, 
however,  be  a  much  simpler  matter  for  the  surgeon  to  se- 
cure it  than  an  abnormal  obturator. 

In  Mr.  Thompson's  second  case  the  common  trunk  was 
larger,  and  crossed  the  external  iliac  vein  at  a  point  corre- 
ponding  to  the  septum,  between  the  compartment  for  the 
vein  and  crural  canal,  the  artery  pierced  the  sheath  and 
split  into  the  deep  epigastric  and  internal  circumflex,  the 
latter  crossed  downwards,  being  in  contact  with  and  to  the 
inner  side  of  the  vein.  In  this  case,  Mr.  Thompson  thinks, 
if  a  hernia  had  existed,  it  would  have  pushed  the  artery  to 
the  outer  side,  and  the  vessel  would  not  have  been  in  any 
danger  should  an  operation  for  strangulated  hernia  have  been 

needed.  .  x,,,^ 

LEFT   SUPERIOR  VENA   CAVA. 

This  occurred  in  an  old  woman  aged  70.  The  heart  was 
considerably  larger  than  normal,  and  its  right  side  and  the 
veins  emptying  into  it  were  full  of  blood.  The  right  cava 
and  transverse  innominate  were  not  much  reduced  in  size  or 
length,  and  were  normally  placed.  The  persistent  left  cava, 
or  rather  the  left  duel  of  Cuvier,  passed  down  over  the  arch 
of  the  aorta  and  root  of  left  lung,  pierced  the  fibrous  peri- 
cardium and  joined  the  coronary  sinus  (which  was  much 
enlarged),  and  through  it  entered  the  right  auricle.  The 
opening  into  the  auricle  was  of  great  size.  The  persistent 
vein  was  about  the  size  01  a  com.mon  lead  pencil,  and  re- 
ceived just  below  the  point  where  the  transverse  branch  was 
given  off  a  large  vein  which  returned  the  blood  from  the 
upper  four  intercostal  spaces.     The  azygos  veins  were  nor- 


■i 


14 


FRANCIS  J.  SHEPHERD. 


mal.     The  thyroid  veins  emptied  into  the  transverse  branch. 
This  is  the  second  example  I  have  seen   of  this  anomaly  in 
two  hundred  and  fifty  subjects  ;  both   occurred   in  adults. 
In  my  other  case^  the    persistent  vein    was  much   lar^^er. 
Both  specimens  are  now  preserved   in  the  museum  of  Mc- 
Gill  University.     This  arrangement  of  the  veins  is  the  nor- 
mal one  in  birds  and  some  mammals,  as,  c.  g.,  the  rabbit. 
Mr.  Marshall  has  ably  worked  out   the  development  of  the 
great  veins  of  the  neck,  and  has  fully  described  the  cause  of ' 
this  anomaly.     Mr.  Walsham  2  has,  lately,    very   fully  de- 
scribed a  well-marked  case  of  persistent  left  cava. 
LARGE  OCCIPITAL  SINUS. ^ 
The  right  occipital  sinus  was  twice  seen,  of  very  large  size- 
quite  as  large  as  the  ordinary  lateral.    In  both  these  cases  the 
lateral  sinus  was  so  small  that  it  would  only  admit  a  probe. 
J.  T.  Knott-''  has,  lately,  fully  described  the  variations  of  the 
lateral  sinuses.  DISPLACED  KIDNEYS. 

In  an  elderly  female  subject,  who  had  borne  children,  the 
kidneys   were   seen   two    inches  lower  than    normal.     The 
lower  end  of  the  left  kidney  rested  on  the  external  iliac  ar- 
tery, the  lower  end  of  right   in  the  iliac  fossa.     The  upper 
end  of  each  kidney  was  below  the  last  dorsal  vertebra.    The 
left   kidney   received    two   branches    from    the   aorta — one 
given  off  normally  entered  the  hilus,  the  other  was  given  off 
from  the  aorta  just  above  its  division  and   entered  the  ex- 
treme   lower   end    of  the  kidney.     On    the   right  side  the 
renal  artery,  before    entering  the  hilus,   divided  into   four 
branches.     From  the  position  of  the  supernumerary  renal 
to  the  left  kidney,  I  should  judge  that  the  left  kidney,  at 
any  rate,  was  congenitally  misplaced.     Both  kidneys  were 
firmly  fixed  in  their  abnormal  position. 

'  Monirea!  General  Hospital  Reports,  vol.  i.,  1880. 

2  St.  Bariholornew's  Hospital  Reports,  1880. 

8  Proceedings  of  International  Medical  Congress,  1881,  vol.  i. 


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